TY - JOUR
T1 - Gluteal, abdominal, and thoracic multiple impalement injuries
T2 - A case report on management of a complex polytrauma
AU - Ugoletti, Lara
AU - Zizzo, Maurizio
AU - Castro Ruiz, Carolina
AU - Pavesi, Erica
AU - Biolchini, Federico
AU - Annessi, Valerio
PY - 2019/5/1
Y1 - 2019/5/1
N2 - RATIONALE: Historically, traumatic injuries include penetrating and blunt lesions. Impalement injury represents one of the rarest and potentially dramatic forms of penetrating trauma. If patient reaches hospital alive and is hemodynamically stable, there is a good chance that patient overcomes the traumatic event. However, non-removal of foreign body represents the cornerstone in initial treatment of this type of patients. PATIENT CONCERNS: A stable 55-year-old woman was admitted to the Emergency Department after falling out of a tree onto a wooden fence. One fence pole transfixed left gluteus, left abdominal wall, left abdominal cavity, and left thoracic wall by transdiaphragmatic way. DIAGNOSIS: Due to patient stability, a chest-abdomen CT scan with contrast medium was performed. It showed multiple parietal and visceral traumatic penetrating injuries from a foreign object. INTERVENTIONS: After primary and secondary advanced trauma life support (ATLS) assessment, patient underwent successful surgery. OUTCOMES: Patient was discharged on 9th postoperative day in good general clinical condition. LESSONS: Impalement injury represents a rare and potentially lethal traumatic event. Unstable patients rarely reach Emergency Department alive. On the contrary, stable patients have a good chance of successful treatment, if they are quickly taken to tertiary Trauma Center. In this case, chest X-ray and Focused Assessment with Sonography for Trauma (FAST) represent useful diagnosing investigations, although CT scan remains gold standard. Conservative treatment is not possible, while thoracoscopy/laparoscopy/laparotomy is/are mandatory.
AB - RATIONALE: Historically, traumatic injuries include penetrating and blunt lesions. Impalement injury represents one of the rarest and potentially dramatic forms of penetrating trauma. If patient reaches hospital alive and is hemodynamically stable, there is a good chance that patient overcomes the traumatic event. However, non-removal of foreign body represents the cornerstone in initial treatment of this type of patients. PATIENT CONCERNS: A stable 55-year-old woman was admitted to the Emergency Department after falling out of a tree onto a wooden fence. One fence pole transfixed left gluteus, left abdominal wall, left abdominal cavity, and left thoracic wall by transdiaphragmatic way. DIAGNOSIS: Due to patient stability, a chest-abdomen CT scan with contrast medium was performed. It showed multiple parietal and visceral traumatic penetrating injuries from a foreign object. INTERVENTIONS: After primary and secondary advanced trauma life support (ATLS) assessment, patient underwent successful surgery. OUTCOMES: Patient was discharged on 9th postoperative day in good general clinical condition. LESSONS: Impalement injury represents a rare and potentially lethal traumatic event. Unstable patients rarely reach Emergency Department alive. On the contrary, stable patients have a good chance of successful treatment, if they are quickly taken to tertiary Trauma Center. In this case, chest X-ray and Focused Assessment with Sonography for Trauma (FAST) represent useful diagnosing investigations, although CT scan remains gold standard. Conservative treatment is not possible, while thoracoscopy/laparoscopy/laparotomy is/are mandatory.
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U2 - 10.1097/MD.0000000000015824
DO - 10.1097/MD.0000000000015824
M3 - Article
C2 - 31145320
AN - SCOPUS:85067277718
VL - 98
SP - e15824
JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries
JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries
SN - 0025-7974
IS - 22
ER -